Food Allergy Counseling

Food Allergy Counseling
Sloane Miller, Food Allergy Counselor (Picture © Noel Malcolm 2013)

Friday, December 12, 2014

Food Allergy Counseling: Study from Northwestern Medicine: Risk Taking Behavior Among Adolescents with Food Allergy

My colleague, Dr Ruchi Gupta sent me the following information about a study she is conducting for teens ages 14-22.  

"The goal of this study is to learn more about the risk taking behaviors of food allergic adolescents – both in regard to general risk taking and risk taking as it relates to food allergy."  

*Nota Bene: I am in no way involved in any aspect this study.*

More information is below from Dr Ruchi Gupta at Northwestern Feinberg School of Medicine, Northwestern University:

Study Overview: Researchers at Northwestern Medicine are conducting a research study entitled “Risk Taking Behavior among Adolescents with Food Allergy," which is currently enrolling participants.  The goal of this study is to learn more about the risk taking behaviors of food allergic adolescents – both in regard to general risk taking and risk taking as it relates to food allergy.  In order to participate in the study, adolescents between the ages of 14 and 22 years who currently have a food allergy are being asked to complete an entirely anonymous and confidential electronic survey. 

No protected health or identifying information is being collected.  No compensation is being offered in exchange for study participation. All aspects of this research study have been approved by the Northwestern Institutional Review Board, IRB STU00097291.

If you are between the ages of 18 and 22 and are interested in participating in this study, please click on this secure link to access the anonymous and confidential survey [https://redcap.nubic.northwestern.edu/redcap/surveys/?s=TcT8XLeZeA].

If you are a parent with a food allergic child between the ages of 14 and 17 and have no objections to your adolescent child participating in this study, please forward him/her this link [https://redcap.nubic.northwestern.edu/redcap/surveys/?s=TcT8XLeZeA].  The link will take him/her to the completely anonymous and confidential survey.

If you have any questions prior to making your decision, please feel free to contact Jacquie, jacqueline.pence@northwestern.edu, or Dr. Gupta, r-gupta@northwestern.edu.

Monday, December 08, 2014

Recipe: Pumpkin Spice Cake With Cinnamon Marshmallow Frosting

As my friend Chris said: my cupcake is wearing a "jaunty beret" of frosting

This is less of a recipe for more like semi-barely-not-really-homemade-but-I-did-use-my-mixer-and-bake-it homemade and all delicious.  I’ve always been severely allergic to tree nuts and seafood (and OAS to some fruits and veg) but since becoming intolerant to wheat, dairy and soy ten years ago, my baking from scratch has been curtailed. 

*Here a link to an explanation from AAAAI.org about the difference between allergy and intolerance.* 

Food allergy friendly mixes have saved the day and I have a few favorite go-tos, like Namaste Foods

CAKE: For this cupcake, I use the Namaste Foods Spice Cake mix and make the pumpkin variation on the box. Namaste is a lovely company that built their own facility in 2011 that is free from: "wheat, gluten, corn, soy, potato, dairy, casein, peanuts and tree nuts, are carefully manufactured in a dedicated allergen free facility and Kosher certified."

From a Namaste Foods 2011 press release: “Operating under the name of Taylor Gleason Enterprises, LLC, the new facility is virtually a one-of-a-kind allergen free facility. In addition to being free of the top eight allergens (dairy, 
egg, wheat/gluten, soy, peanuts, tree nuts, fish and shellfish) the facility is also free of corn and potato. It is estimated that 30 percent or more of the people with food allergies have multiple allergies. Being free of so many allergens demonstrates Namaste’s commitment to people with
food allergies above and beyond other manufacturers."

So yum!

FROSTING: And this is simply my new go-to frosting recipe. It's nut-free, dairy-free, gluten-free, soy-free and oh my goodness worthy.

Marshmallow Frosting

By Lori Karavolis and further adapted by me




1 C Domino’s confectioners’ sugar

1/2 C Spectrum organic palm shortening

1 C Durkee’s marshmallow fluff

1 t Nielsen-Massey vanilla extract

2 T hot water

Pinch of kosher salt


Mix well and try not to spoon directly into your mouth.

***

The reviews of this cupcake: 
“Do you have more?”
“You could sell these.”
"The frosting. The pumpkin cake. The frosting. YUM!!!!! So amazing!"

My uncle loved them so much that he created a thank you card featuring me and my mother atop the cupcake!



Friday, December 05, 2014

Food Allergy Counseling: Family, Holidays and Food Allergies



I read this New York Times opinion piece by Frank Bruni about his Italian American family - On Thanksgiving, an Abundance That's About Much More Than Food and his Thanksgiving which he likens to “…. a forced march, only a catered one, with prosciutto” and thought, even though my family is not Italian American, anyone with food allergies can relate to the sentiment, especially on Thanksgiving. 

Bruni goes on to say: “We Italian-Americans exalt food because we Italian-Americans exalt family. They’re intertwined. Indistinguishable.”

Many cultures express their love through feeding each other. Ahem, I’m looking at you my Jewish brethren. And when you have severe food allergies and cannot indulge in beloved family recipes, sometimes feathers get ruffled. Or worse, rifts can form.

So how do you initiate a loving conversation with extended family about the holiday season? 

Here’s a handy solution for only $1.50, the family e-chapter from my book Allergic Girl: Adventures in Living Well with Food Allergies.

You can download this chapter, Allergic Girl Family Guide to Food Allergies from Barnes & Noble or Amazon.com’s Kindle Store

If you want a more personalized approach, contact me about a short term counseling program today.

Monday, December 01, 2014

Interview: Chef Matt Abdoo, Del Posto

November centerpiece

Cool, marble floors. Low, romantic lighting. A dark wooden bar. A sweeping staircase headed to parts unknown. Even at 9:00am, Del Posto is stately; a Tuscan Castle dropped onto Tenth Avenue. Which is exactly what happened ten years ago when the B&B group transformed a former Nabisco factory into their New York Times four star rated restaurant Del Posto. (Read the glowing review here, written by Sam Sifton’s deft and poetic hand.) Against the cool floors and steep prices, there is a ton of warmth to be had. It’s emanating from the kitchen, in part from Chef De Cuisine, Matt Abdoo

Picture of Chef Matt Abdoo copyright Matt Abdoo
I interviewed Chef Matt for an Allergic Living Magazine article about the third annual Allergy Eats Conference. (You can read that interview in the Winter 2015 issue.) I was particularly struck by Chef Matt’s passion for food, for his guests, his attention to food allergy details and that he kept using the word love over and over again in his presentation: he loves food, he loves his job, he just wants his patrons to leave happy and feeling the love.

Recently, I had a chance to have a deeper conversation with Chef Matt about Del Posto’s food allergen and gluten-free programs, created with Executive Chef Mark Ladner. (Please note, I have not yet dined at Del Posto.)


***

Allergic Girl: In the last few years, Del Posto made a splash by creating the first high-end (that I know of) fresh gluten-free pasta menu/options in New York City. How did the gluten-free program start?

Chef Matt Abdoo: About four years ago, we were noticing that more and more guests with dietary restrictions or allergies, whether it was to wheat or gluten. As we encourage our guests to order the price fixed menu with the taste of two pastas, we always felt badly if a guest couldn’t partake in the most courses.

We had always dried, commercially made gluten-free pasta available, we used rusticella d’albruzzo rice penne and corn fusilli, and if someone came in, we’d put on a separate pot of water and we’d use the same sauce so they could have something similar to other diners. 

But we wanted to go a step further so these diners could have the same exact thing like the other diners. And that has been the driving force for a lot of our work to create a gluten-free pasta program: to mirror our Del Posto entire experience but gluten-free. 

(AG: Del Posto uses Cup4Cup as the basis for their gluten-free pasta. It involves egg and dairy. Here’s more about Cup4Cup.) 

AG: Were the chefs and staff always so aware of dietary restrictions? Or has something changed since Del Posto opened ten years ago?

MA: What’s changed, more so than anything, is that dietary restrictions and allergies have risen. More and more people are discovering they have some kind of restriction and we need to be able to accommodate those guests in one way or another.

What hasn’t changed at Del Posto is that whether a guest doesn’t have a single dietary restriction and they are just blown away by the food or if they are a guest who says ‘I’m really hard to accommodate”, we at Del Posto always find a way to accommodate them and give them an experience that is memorable and that blows them away. 

That’s what’s important to us. We want to be able to make our guests happy. We want to be able to fulfill an experience that is above and beyond anything that they thought was possible.

So, accommodating our guests with allergies and dietary restrictions is no different than how we have been and would accommodate any other guest.

AG: What is the procedure, generally, when a food allergy or gluten-free order comes into the kitchen at Del Posto? (NB: The process is more extensive and detailed than what is below, this is just a sample of some of the steps they stated that they take.)
MA: When guests make a reservation at Del Posto, our reservationists are trained to ask if there are any dietary restrictions in the party, and so the very first point of contact with guests is an attempt to get any pertinent information regarding allergies. 

The reservationist will then note the restriction on the reservation for the main dining room staff and the kitchen to be aware of from the get-go.

During dinner service, all tickets that include orders for food allergic guests or dietary restrictions of any kind include that guest’s seat number, as well as a special notation each time a ticket comes in.

Once the tickets are in the kitchen, they are marked with red dot stickers, which serve as a visual cue for everyone involved that there is a dietary restriction at the table.

Chef Matt and the red dot sticker for allergy plates 

Each plate for a food allergic guest is marked with a red dot sticker, and then hand delivered by a manager when the food walks for that table.

Finally, and most importantly, we do our very best to keep cross contamination at a minimum. Food is cooked in separate vessels that are free from the specific allergy in question- pans, pots, water, and special spoons are all used.

AG: That’s extensive. What about raw products?
MA: The food allergy process at Del Posto begins, in fact, with receiving products and inspecting products. An employee goes through all deliveries to ensure that the correct items have been delivered, and that those items have not been subjected to potential contaminants, for example: we don’t want to see a bag of almonds on top of a bag of wheat flour. 

To this end, our receiver also makes sure that all the ordered goods are in the appropriate condition. We do not accept dented items, or anything that looks tampered with. It’s a lot of work-- training your staff what to look for-- but it’s necessary.

The next step is processing ingredients. We make sure that all team members are aware of the top 8 allergens: shellfish, soy, milk, eggs, tree nuts, peanuts, fish and wheat.  When we are producing allergy friendly dishes they are prepared in a work environment free from the top 8 allergens, and all ingredients are treated with extra care and concern. 

For service and the service team, we provide extensive staff training, from meeting to pop quizzes, to testing, and a huge number training documents available to study from.

And then we wait for the reservation and enact those procedures I mentioned before.

AG: Incredibly extensive! So, in your opinion, generally speaking, what mistakes should a diner with food allergies watch out for when any restaurant is handling a food allergy or special diet order?
MA: There should be clear and continuous communication throughout the entirety of the meal with managerial staff. If there isn’t, that is a red flag.
Additionally, guests should watch out when the food is not delivered by either the manager or the person that took the order.
Make certain that the person you have been interacting with about your food allergies or their superior is the one that is looking out for you and understanding that your plate has a special request on it.
For example, at Del Posto, we require that a manager is the one point person who has contact with a guest with a food allergy request and sees it all the way through to delivery.
If when a manager delivers your meal to the table, if a discreet announcement is not made with eye contact about your special requests, it may not be your meal. Don’t eat if you are unsure.
AG: What are the top three things you need to hear from a guest to accommodate them when dining at Del Posto?

MA: 
1. What a guest can not have. 
2. What a guest can have. 
3. What they had last visit, if there was a last visit. 

If they have chef or restaurant card, use it. We love the card.

As chefs during a busy meal service, we’re processing a thousand things at once. When an allergy order comes in, we stop. And then our brains have to reprocess and go through every ingredient to every dish according to your needs, and we check and double check, because we get nervous and get scared. So, if you use a chef card or something like Sloane's word document and tell us what you can have, as well as what you can’t, it’s great!

AG: I know many people with severe dietary restrictions feel like chef cards or giving lists of can/cannot haves flags them as a difficult or undesirable guest. Do you agree? Basically, what’s the perception of special requests?
MA: Here at Del Posto every guest is welcomed like your Italian grandmother would; with a warm, welcoming hug. We love getting the information about you that will help us serve you better and safe and make you comfortable. 
AG: What’s the best way a diner should get in touch with Del Posto to start a dialog about dining with you, especially if they have severe food allergies or special dietary requests?

MA: Call (212.497.8090) or email us through opentable.com. The most important thing is that you reach someone and get a confirmation of your needs.
***
Thank you, Chef Matt and the Del Posto team for all that you do for guests with severe food allergies and dietary restrictions!
Del Posto
85 10th Avenue 
New York, NY 10011
(212) 497-8090

Monday, November 17, 2014

Food Allergy Counseling: A Letter to my Musical Improv Teammates



Request re: Sloane's tree nut & fish allergies

Dearest Teammates and Coach,

This hasn't come up yet but eventually someone's going to eat a Kind bar or some raw cashews before a practice or show and then wonder why I don't want to touch them during a scene.

Trust me, it's not you; it's the nuts.

I'm severely allergic to tree nuts (cashews, brazil nuts, walnuts, almonds, pistachios, etc.) and salmon.

If you wouldn't mind refraining from eating food items containing these ingredients before or during our practices or shows, I'd deeply appreciate it.

Any questions or concerns, I'm here!

Thanks!

***

Back in September, I auditioned for and was cast in a musical improv house team; "house" means we are regular players at a particular place. There are eight of us on a team, plus a coach and a pianist. We practice weekly and perform twice monthly. It's so fun I can’t even contain my joy in being able to do this regularly.

I have been in classes learning this new skill for the past two years and over that time have watched many of my classmates snacking on raw, roasted, candied nuts in various forms during practices and before shows. Nothing ever happened, a severe anaphylactic reaction from casual contact would be highly unlikely (read more about that in my interview with Dr Dave Stukus), and it hasn’t happened yet in my life and I go out socially at least 5 nights a week.  However, it didn’t make me feel super comfy about rolling around with everyone especially when their nutty hands reach out to touch my face.

Since I’m on a team now, with regular performers, performing weekly I thought I should mention something, mainly because I want to be able to be close to them and not fear spitty talker or nutty hands. *Again, nothing serious nor life threatening has ever happened with casual contact with me, maybe a hive or two or an itchy cheek but nothing near systemic nor anaphylactic. This is more about mental comfort than a physical reality.*

So, I sent the above note. I saw everyone two days later for rehearsal and there was one collective thought from my team: “Cool, no problem. We don’t want to hurt you.”

What a wonderful feeling to put out a clear direct request and receive a clear direct reply.

And I’m back to rolling around with my team!


Friday, November 14, 2014

Recipe: Tree-Nut Free, Gluten-Free Birthday Cake with Marshmallow Frosting

Birthday cake perfection
I start celebrating my birthday pretty much the moment after Halloween until around Thanksgiving; that is, the better part of November. I start thinking about my birthday cake way earlier. I’m not a chocolate looooover, I’m more of a vanilla person but for some reason I do love chocolate cake with white icing and that is my recent (like last twenty years) choice for birthday cake. 

I usually make cupcakes because everyone can have their own mini-cake and they are easy to transport or set out on a pretty platter. And also, let’s get real, there's a higher ratio of frosting to cake in a bite per bite level. At least in my household.

I did a trial run of whoopie pies earlier in the month, thinking maybe that would be something fun to do but it didn’t feel celebratory enough. I wanted cake. But that marshmallow–based frosting for the middles turned into a small obsession. (More about how the Durkee Marshmallow fluff factory works here.) I decided to make cupcakes with a new frosting recipe and everyone who has tried it has gone gaga for it. One rave from my pilates instructor: “Every cake should be that cake. Every frosting should be that frosting.”

I agree. 

Is this a recipe? Not exactly.  More like semi-barely-not-really-homemade-but-I-did-use-my-mixer-and-bake-it homemade and all delicious. 

CAKE: I use King Arthur Gluten-Free Chocolate cake mix. I use their instructions on the back. It’s made in a top 8 facility, even though the package doesn’t say it anymore. They changed the label because they don’t test for those allergens and didn’t want to be unclear; they only test for gluten. I emailed with them this week to triple check. And yes, all the same. Please call them directly if you have any questions.

MORE CHOCOLATE: I add Enjoy Life Mini Chocolate Chips to the batter, a handful or two for funsies.

FROSTING: I made two batches of this frosting recipe that I slightly altered.

Marshmallow Frosting

By Lori Karavolis and further adapted by me



1 C Domino’s confectioners’ sugar

1/2 C Spectrum organic palm shortening

1 C Durkee’s marshmallow fluff

1 t Nielsen-Massey vanilla extract

2 T hot water

Pinch of kosher salt

Mix well and try not to spoon directly into your mouth.

The result is above and here again.




It’s so easy to throw together and everyone, with dietary restrictions or without, loves. Most of all this birthday girl. 

Enjoy!

Thursday, October 30, 2014

Recipe: Sandwich Cookies, Nut-Free, Gluten-Free

Finished sandwich cookie of goodness

So I got it into my head that I wanted to make an Allergic Girl friendly Whoopie Pie for my birthday. I don’t think I’ve ever had a whoopie pie growing up (my mom’s confirms, we didn’t have them in the house); moon pies at camp yes, with marshmallow filling and graham cracker, enrobed in chocolate, but whoopie pie, nope. 

The last few years I (or Brooklyn Allergy Mom) made safe for me birthday cake that was chocolate cake with white icing, which is my favorite flavor combo. I use King Arthur Gluten-free Chocolate Cake Mix and this dairy-free buttercream recipe.

This year I thought, let me try a whoopie pie. I looked up on Google who was making them gluten-free and nut-free and I also wanted to use a mix that was safe for me like  King Arthur Gluten-free Chocolate Cake Mix or Betty Crocker Gluten-Free Devil's Food Cake Mix.

I found this GF Whoopie Pie recipe online. It’s based on Cake Mix Doctor Bake Gluten-Free's recipe, whose book I really liked and I reviewed here. When I looked at the original recipe  in Anne Byrn’s book, it had way more ingredients and steps. As this GF Whoopie Pie recipe looked simpler, I thought I’d try.

The upshot: the finished product was delicious. Several fellow musical improvisers, none with food allergies or dietary needs, all loved and were licking their fingers looking for more.


The cookie is fudgey and cakey, with a dark cocoa taste. It's not overly sickly sweet, which I like, a lot. Even with the filling, it's a great balance of texture and sweetness.


Cooling cookies

The inside the cakey part and the edges have a little crusty texture. A nice mix of textures overall.


Inside view of the cookie

The filling is very soft when made, which is why the top cookie looks like it's sliding off; because it is.



I don't know that cooling the filling once made would help but the filling sets-up and gets firmer once chilled. So there's that.

And I don’t know that I would call it a whoopie pie. Having said this, one of my testers, upon having a bite, said, “What a great whoopie pie!” 

I prefer to think of it a super yummy sandwich cookie. I would make them again. But for my birthday, I'm sticking with cake.

The recipe as written bellow is gluten-free, tree nut free, peanut-free and can easily be made dairy-free. Here is the recipe with my substitutions. 

Enjoy!

***

Recipe, Sandwich Cookies, Nut-Free, Gluten-Free
By Lori Karavolis and Anne Byrn, further adapted by me


Cookies:
1 -15 ounce box GF Betty Crocker Devil’s Food Cake Mix
2 medium size organic eggs 
5 T melted organic butter (or diary-free substitute)

Filling:
1 C confectioners’ sugar
1/2 C vegetable shortening (I used palm shortening)
1 C marshmallow fluff
1 t vanilla extract
2 T hot water
Pinch of kosher salt

Preheat oven to 350 degrees. Place all cookie ingredients in heavy duty mixing bowl; mix well. It will be dry looking. That's correct, don’t worry. Using a scoop or a teaspoon, shape batter into 1 inch balls and place 2 inches apart on parchment-lined baking sheets. Bake for 8-10 minutes or until set. Allow cookies to cool 5 minutes on baking sheets before removing to a wire rack to cool completely. 

As cookies are cooling, make the filling. Place the filling ingredients in a mixing bowl and beat until smooth. 

To make sandwich cookies, spread a heaping teaspoon of filling onto the flat side of one cookie. Top with a second cookie to make a sandwich. Repeat with remaining cookies and filling. Chill to set as they will be sloopy.

Yield: 15 Sandwich Cookies

Friday, October 17, 2014

Food Allergy Counseling: Interview with Tarah Jakubiak, Allergic Traveler

I first met Tarah at a FARE walk years ago when I was promoting my lifestyle guide  Allergic Girl: Adventures in Living Well with Food Allergies (Wiley, 2011) (available online or at your local bookstore). Tarah is another adult with food allergies who has create a business that support people with food allergies living their best fullest lives- yay!

Tarah created Allergic Traveler, food allergy chef cards in multiple languages that can be used for dining out as well for your child’s backpacks for when they are away from you or home. From the Allergic Traveler website:

“…what happens when you are traveling, for pleasure or business, and you need to communicate with the waiter that you are allergic to nuts in French? That is the premise behind this Allergic Traveler, LLC… All translations are done by native speakers in order to ensure the accuracy of such an important translation.”

As Tarah says:  “My ‘Allergic Traveler’ card has given me the freedom to see the world and I hope it can do the same for you.”
  
Recently, I had a chance to ask Tarah a few questions about being an adult with food allergies and how she got the idea for her business, Allergic Traveler. Want to read what I said to Tarah? Read more on her blog. 

*** 

Sloane Miller: What’s your personal connection to the food allergy community?

Tarah Jakubiak: I have lived with food allergies my whole life. As a child I was diagnosed with multiple food allergies after being rushed to the hospital for the umpteenth time; I stopped breathing. Eventually I was blood tested and my parents discovered the root of my hospital visits was due to my allergy to eggs, tree nuts, mushrooms, and shellfish.Today my whole list of allergens comprises of eggs, nuts, mushrooms, celery, peanuts, soy, garlic, chicken, pork, corn, shellfish, sesame and I have oral allergy syndrome (OAS) to most fruits.

Miller:  Tarah, tell us about your professional background:

Jakubiak: My background lies in marketing, advertising and sales management. I have spent more than 20 years working for companies to help their business grow. Having an extensive business background and multiple food allergies, I saw a need for our product, and I was completely aware of how to bring it to the market place.

Miller: What does Allergic Traveler do and what was the reason why you created it?

Jakubiak: I have traveled my entire life whether it is for business or pleasure. Around 2010, I went on a Mediterranean cruise. We would be stopping in multiple countries and I needed to be able to communicate my allergies in many languages. I started sketching out some cards. I realized there was a need for this so I created Allergic Traveler to use on my trip.

The reaction I received from testing out my product personally was overwhelming. Waiters actually thanked me for being so prepared. Shopkeepers were able to help me with my groceries. This reaction solidified the need to found Allergic Traveler and in 2011, we launched our online business.

Allergic Traveler produces dietary allergen cards for those in need of communicating their restrictions. Cards are available in English and 17 other languages. Each one is customized. They are available in wallet and luggage format. The luggage format is popular with young kids as they attach them to their back packs while on field trips or sleep overs.

Today people use our cards while eating out, while traveling, while away at college and in many other settings. 

Miller: What is the best piece of advice you have for people newly diagnosed with food allergies?

Jakubiak: To the parent of the food allergic child, I would say, “It will be OK. Trust yourself and your child will be well prepared. There are many obstacles that will be put in your way but take comfort in the fact that there are many more resources, including support, out there today.”

To the child or adult with food allergies, I would say, “Make the best of your situation. Become a great cook and spend some time learning new cuisines. Do not forget to give back to the food allergy community as only you can understand what we really need.”

Miller: What are your interests outside of work? What gives you joy?

Jakubiak:  I love to travel when I am not working. I like to experience a new culture, to get lost in new neighborhoods, to meet people with different customs, to learn about their cuisine, to absorb whatever they are prepared to teach me. And of course my loved ones bring me great happiness. No matter the situation to spend time with a loved one is always a gift and it never lasts long enough.

**


Thank you,Tarah, and Allergic Traveler for all that you do to support us getting out there safely!